What is a root cavity, and how is it treated?

root cavity

The root is the part of the tooth embedded in the bone and holds the tooth in place. The gums attach to the teeth at the junction of crown and root, and that’s why you can’t see it in people with healthy gums. However, in certain circumstances, one or more tooth roots get exposed and develop decay, known as a root cavity, root decay, or root caries.  

Demographics of a root cavity

Root cavities often affect middle to old-aged people with exposed tooth roots. Root cavities are rising because of increased life expectancy and a simultaneous reduction in tooth loss worldwide in older adults due to advanced dental treatment methods. 

Approximately 15-27% of people above 75 years suffer from root decay in Australia and New Zealand.  The current generation of older adults has fewer root caries than the previous generation because of water fluoridation and a healthy lifestyle.

Causes Of Root exposure and root Cavities

Periodontal or gum disease is the most common reason for root exposure. Plaque deposition above and below the gums due to improper oral hygiene initiates gum disease. If the plaque is not removed within 48-72 hours, it calcifies into tartar, which firmly adheres to the teeth and can’t be removed with a toothbrush.

Prolonged and continuous plaque deposition in the shallow pockets between the teeth and gums irritates the pocket lining. It detaches from its original level, allowing it to migrate toward the root, exposing the tooth’s root. 

Related article: how to reverse gum disease?

Unlike tooth enamel, the roots of the teeth are less resistant to destruction by oral bacteria. They are less mineralized and contain more organic material and water and thus are easily attacked by bacterial acid. 

Aging, uncontrolled diabetes, heart disease, and aggressive tooth brushing also increase the chances of gum recession. 

As mentioned earlier, a root surface contains more organic matrix, which is prone to degradation by bacterial acids. The bacterial acids from dental plaque induce demineralization and exposure to the organic matrix on the root surface. They also activate the dentin-embedded and salivary enzymes responsible for the degradation of the demineralized organic matrix. This root destruction allows bacteria to attack the root surface and cause root cavities.

Related article: Why is the pH of the saliva important?

Symptoms and Symptoms of a Root Cavity

Root caries affects people over 45 years and above. You may feel or experience one or more of the signs and symptoms if you have a root cavity:

  • A yellow to light brown discoloration along the gum line with a soft and leathery texture. The soft lesion indicates an active disease and needs prompt treatment to stop its progression. 
  • A dark brown to black discoloration along the gum line, which is hard, indicates an arrested lesion and may left untreated if the appearance is not a concern.
  • Sensitivity to heat, cold, sweet foods, and drinks.
  • A dull, constant toothache or more severe, sharp tooth pain on the root exposed tooth.
  • Swelling or redness in the gum tissue around one tooth.
  • A tooth that feels loose.
  • Gum tissue recession.

Risk Factors for a root Cavity

The risk factors that put you at risk of root cavity are:

Cigarette Smoking 

Smokers develop more gum recession and root decay than non-smokers. Tobacco and other products in cigarettes lower the acid-neutralizing capability of saliva and, thus, increase the chance of root erosion. Moreover, it also favors the growth of tooth decay-causing bacteria, such as mutans streptococci and lactobacilli, in the mouth.

Male gender

Men often get more root cavities than women. The reason is the negligence towards oral and general health. It is commonly seen in medical and dental practice that most men seek treatment when there is a serious concern with their health. Women intercept problems early and are thus less likely to get them. Moreover, often, men miss their routine or annual dental checkups. 

Poor Oral (Mouth) Hygiene

Root exposure and root cavities occur in people with poor oral hygiene. Regular brushing with an extra-soft bristles toothbrush with fluoridated toothpaste and flossing removes plaque from the teeth. Moreover, fluoride in the toothpaste incorporates and strengthens the teeth, thus creating resistance against root caries.

Related article: Can gum disease kill you?

Low social Status

People with low social status bear the most caries burden because of their poor lifestyle and limited access to dental care. A combination of these factors increases the risk of root cavities.

Treatment of a root cavity

Treatment strategies for root cavities rely on the size, depth, location of the cavity, aesthetic requirements, and patient’s physical condition.

Fluoride Treatment 

Early cavities are often treated with fluoride treatments. Professionally applied high-fluoride varnish and high-fluoride toothpaste successfully control root decay.

The deep root cavities may also benefit from the remineralizing effect of the fluoride treatment. However, they require the removal of soft decay, leaving the hard discolored dentin behind. A hard, discolored root signifies an arrested decay. The fluoride varnish is applied over the clean, discolored, and disinfected root surface. 

Root filling 

Glass-ionomer cement or composite fillings are generally used for repairing a root cavity. However, root fillings often fail due to poor visibility, access to the cavity, and inability to keep the area dry as fillings bond best to the dry tooth with no moisture. Therefore, in cavities where it is difficult to maintain a dry field, the soft decay is removed, and the cavity is treated with a fluoride-releasing varnish.

Prevention Of a root cavity 

  • The acid-producing bacteria in the mouth feed on simple sugars and are a major cause for both coronal and root cavities. However, good oral hygiene and dietary changes can prevent root caries. 
  • A healthy diet rich in fibre naturally brushes away bacteria and plaque from the teeth. Additionally, drinking fluoridated water and fluoride from other food sources help keep root cavities at bay.
  • You may be advised specific measures like the use of electric toothbrushes and chemical plaque control measures if you are medically compromised or have impaired manual dexterity.
  • Prevention of root caries goes hand in hand with controlling gum recession. A correct brushing technique and the use of soft toothbrushes not only removes the plaque but also protects the gums from receding . 
  • The ability to carry out daily activities and intellectual functions diminishes with age and age-related diseases such as dementia results in functional limitations among older adults. This disrupts their normal daily activities like oral hygiene practices etc. If you have an older member in your family, it is important to frequently take them to the dentist. They will guide you about the risk factors and preventive measures for root cavities. 


Root cavities are common in middle to old-aged people and peak in people above 70 years. A yellow to brown discoloration along the gum line is the sign that you have a root cavity.

Factors like old age, male gender, low socioeconomic status, infrequent teeth brushing, missing regular dental visits, smoking, and dry mouth are associated with root cavities.

Fluoride varnishes work best for early cavities as well for the ones that aren’t accessible. Glass-ionomer cement, or composite fillings are reserved for moderate to deep cavities.

Improved oral hygiene practices, locally applied preventive measures, good dietary habits, and regular dental check-ups are approaches to prevent both the progression of gum disease and root caries.

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